it may also be related to the much higher levels of diagnosed heart disease in the United States. Through high levels of diagnosis and treatment, however, the levels of measured risk from high blood pressure and cholesterol—two major cardiovascular risk factors—have been reduced below those in most of the comparison countries. National levels of obesity, which are related to national levels of diabetes, may explain the high levels of the latter condition and its relative contribution to loss of life expectancy in the United States.

In many ways, Japan is the antithesis of the United States. Its population has relatively little heart disease and diabetes; functioning is good, and disability is low. In addition, a number of cancers are quite low in terms of both incidence and mortality in Japan. On the other hand, Japan has managed to be the world leader in life expectancy despite relatively high levels of high blood pressure and stroke. While the United States and Japan line up well at the extremes of longevity and disease prevalence, the association is less clear for other countries. In particular, while they share poor life expectancy trends with the United States, the Netherlands and Denmark differ from the United States in a number of aspects of health. They report relatively low levels of heart disease and diabetes and have relatively little disability. On the other hand, women in these three countries report more stroke than those in other countries. While morbidity and disability supply some pieces to the longevity puzzle, then, their signals are somewhat ambiguous.



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